EHRs: Lots of Documentation But Little Communication

Greg A. Hood, MD

Disclosures

December 16, 2015

In This Article

Change on a Grand Scale

In the world of technology, a whole lot has changed over the past 18 years. But not everything has been improved.

In 1997, Microsoft released Internet Explorer 3.0 and announced that future generations of Windows would support DVDs. Apple's CEO Gilbert Amelio named Steve Jobs and Steve Wozniak as advisors on the company's executive committee and introduced the Newton MessagePad 2000, with 5 MB of RAM.

Cell phones had shrunk to a handheld form by 1997, and some could even be counted upon to have more than an hour of talk time from a single charge. Also in 1997, I bought an electronic health record (EHR). I selected it because this platform offered the greatest ability to fashion notes that captured the spoken word, as if transcribed by hand or from dictation, for a grand total of $300!

There have been many good changes since 1997, like the incomparable advances in computers and cell phones. Some things haven't changed, though, such as the inability of mainline EHRs to readily incorporate the nuanced, spoken word into notes in a smooth, efficient, or, dare I say, even a predictive manner. Speech recognition has obviously come a long way, but that hasn't translated into an increase in efficiency. It's merely a way to afford transcription services without having to hire a transcriptionist. Consequently, I still use my $300 EHR—copying and pasting into the "SOAP" format of the practice's official EHR.

Most EHRs Continue to Frustrate Clinicians

In spite of assurances from vendors, complaints continue to run bitterly deep from physicians and surgeons about the major players in the EHR market.[1] The community consensus is that a lot of us could do without EHRs. As professionals with exacting standards, it's intensely disappointing to see in EHRs a tool that doesn't rise to meet those standards. Physicians maintain these precise standards because the health and lives of their patients utterly depend on it.

Consequently, any discussion of these shortfalls is generally lost on those who feel that change is inevitable and that point-and-click or drop-down menus are "good enough." Similarly, those who see EHRs primarily as a data-harvesting platform, by which reporting metrics and guideline compliance may be achieved, miss the essential humanness of physician-patient interactions in their rush for technocratic perfection.

Nothing succeeds in glazing over the eyes of nonphysicians like "talking medicine." Perhaps, instead, a recent profile of Robert Macfarlane in a BBC article[2] may be able to illustrate the symbolism of what's being lost to those who don't work with patients, and with words, the way we do.

Macfarlane, a leading nature writer, has made an avocation of gathering together a lexicon of unusual and extraordinary words that describe nature and natural phenomena. The world he describes—and the manner in which he does it—could serve as a model for communication in healthcare.

Macfarlane, the BBC article explains, is "an explorer of hedgerows and roadsides, salt marshes and sea-caves," much as physicians explore prickly lists of differential diagnoses, testing reports, and physical examinations. As one would expect from a consummate, accomplished professional, he's "also a magician, of sorts—one who weaves spells using lost phrases that recall a different connection with our landscape."

By comparison, consider that genteel mentor[3] from your training or early years, from whom you would always hear the most professional, perfectly nuanced narratives of patient care. Did that not seem to come from an almost mystical combination of wisdom and experience? How may such stories may be told, if constrained to click-buttons and drop-down menus?

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